Michael G

345 views

Published on

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
345
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
2
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide
  • The Hague is the 3 rd largest city in the Netherlands, with 440.000 inhabitants. The number of drug adicts
  • Ik wil bij enkele nieuwe voorzieningen stilstaan. Forensisch ambulant is het geheime wapen geworden, omdat we denken dat het een slimme mix is geworden van forensisch psychiatrische (bemoei)zorg: met al die kenmerken die ik zo straks noemde (geen contraindicaties, proactief / optimistisch) De MJD die een absolute maatschappelijke bodem onder het bestaan van de meeste patiënten helpt leggen (budgethulp, fondsen, verzekeringen, ID papieren, etc etc) De GGZ reclassering die zorgt voor de toeleiding zorg en het organiseren van drang (via toezicht en trajectbegeleiding), z.n. terugmelden, etc.
  • Iets over resultaten. In 2002 is de veelplegersaanpak van start gegaan. Op stedelijk nivo zien we sindsdien een forse daling van de vermogenscriminaliteit, eigenlijk voor alle typische veelplegersdelicten Het eerder genoemde veelplegersonderzoek probeert de diverse factoren (detentie, zorginterventies) te relateren aan het recidivegedrag van de deelnemers. Kortom we weten nog niet wat werkt en Wat de resultaten op lange termijn zijn?
  • Hier zien we een politiemaat voor de criminaliteit van de groep veelplegers. Dwz de gemiddelde veelpleger is minder crimineel geworden. In ieder geval tot 2005, daarna zien we een stabilisatie en wellicht lichte stijging, maar op een veel lager nivo. Ook hier is nog niet te zeggen wat incapacitatie effect is en wat het aandeel van zorginspanningen.
  • Dames en heren, Ik heb met u stilgestaan bij een interessante uitdaging voor de GGz, zeker in de grote steden, maar ook daarbuiten, die zich vooral laat samenvatten als uiterst interessant, veelbelovend en erg zinvol. Er is nog veel te doen, maar wij zijn trots op wat onze medewerkers tot stand brengen met echt ingewikkelde doelgroepen, maar tegelijk dankbaar voor alle partners (incl de CR!) en financiers die het mogelijk gemaakt hebben. Literatuur Drangbehandeling Belenko S. Research on drug courts: a critical review 2001 update. The national center on addiction and substance abuse at Columbia University Bullock T. (2003) Key findings from the literature on the effectiveness of drug treatment in prison. In: Ramsay M. (ed) Prisoners’ drug use and treatment: seven research studies. Home office research and statistics directorate, London. Gezondheidsraad (2002) De behandeling van drugverslaafde gedetineerden. Gezondheidsraad, Den Haag. Godley S.H., Finch nM. Dougan L., e.a. (2000) Case management for dually diagnosed individuals involved in the criminal justice system. J Subst Abuse Treat 18:137-148 Hubbard R.L., Craddock S.G., Anderson J. (2003) Overview of 5-year followup outcomes in the drug abuse treatment outcomes studies (DATOS). J Subst Abuse Treat 25:125-134 Hurk, van den A.A., nelissen P. (2004) What Works, een nieuwe benadering van resocialisatie van delinquenten. Ministerie van justitie DJI, Den Haag Inciardi J.A., martin S.S., Butzin C.A. (2004) Five year outcomes of therapeutic community treatment of drug-involved offenders after release from prison. Crime and Delinquency 50:88-107 Koeter M.W.J., Maastricht A.S. (2006) ZonMw, Programma Verslaving, Den Haag Kogel, C.H. de, Nagtegaal, M.H. (2008) Toezichtprogramma's voor delinquenten en forensisch psychiatrische patiënten Min. Van Justitie/WODC, Den Haag. Lipton D.S., pearsons F.S., Cleland C.M., e.a. (2002) The effects of therapeutic communities and milieu therapy on recidivism; meta analytic findings from the correctional drug abuse treatment effectiveness (CDATE) study. In: McGuire J. (ed) Offender rehabilitation and treatment / effective programmes and policies to reduce re-offending. Wiley and Sons, Chichester, pp 39-77 Malinowski A (2003) What works with substance users in prison? Journal of Substance use 8:223-233 McGuire J. (1995) What Works: reducing reoffending. Wiley and Sons, Chichester Ooyen van M., (2004) Drang bij criminele harddruggebruikers. Een onderzoek naar de toepassing van drang in Nederland. Tijdschrift voor Crimionologie 46:233-247 Pearson F.S., Lipton D.S. (1999) A meta-analytic review oftheeffectivieness of corrections-based treatment for drug abuse. The Prison Journal 79:384-410 Perry, A. e.a. Interventions for drug using offenders in the courts, secure establishments en the community (Cochrane collab. 2008, review) Prendergast M.L., Hall E.A., Wexler H.K. e.a. (2004) Amity prison-based therapeutic community: 5 year outcomes. Prison Journal 84: 36-60 Smith, L.A., Therapeutic communities for substance related disorders, (Cochrane collab. 2008, review) SVG werkgroep Interventiematrix JVZ (2004) Interventies voor verslaafde justitiabelen. Stichting Verslavingsreclassering GGz, Amersfoort. Vermeulen K, Hendriks V.M., Zomerveld R. (2000) Drangbehandeling in Den Haag. Evaluatieonderzoek naar de effectiviteit van het behyandelprogramma Triple-Ex voor justitiabele verslaafden. Parnassia Addiction Research Center, Den Haag Wartna B.S.J., Tollenaar N. (2004) Bekenden van Justitie. Een verkennend onderzoek naar de “veelplegers”in de populatie van vervolgde daders. Boom juridische uitgevers, Meppel. Wartna B.S.J. Baas N.J., Beenakkers E.M.T. (2004) Beter, anders en goedkoper: een literatuurverkenning t.b.v. het traject Modernisering Sanctietoepassing. Min. Van Justitie/WODC, Den Haag. Wexler H.K., DeLeon G., e.a. (1999) The Amity Prison TC evaluation: reincarceration outcomes. Criminal Justice and Behavior 26:147-167
  • Michael G

    1. 1. The role of the Dutch addiction services in the approach of addicted repeat offenders drs. Chris van der Meer Man. Director Palier EFTC conference June 4th 2009 Eyes on the Future
    2. 2. Overview of presentation <ul><li>Introduction </li></ul><ul><li>The Repeat Offender Project (ROP) </li></ul><ul><ul><li>The project participants </li></ul></ul><ul><ul><li>Characteristics of top 500 group (demogr., MH, crim.) </li></ul></ul><ul><li>Role of Addiction Services and MH Probation </li></ul><ul><ul><li>Treatment modalities and subgroups </li></ul></ul><ul><ul><li>Reintegration modalities </li></ul></ul><ul><ul><li>Results of TX </li></ul></ul><ul><li>Results of the ROP </li></ul><ul><li>Conclusions </li></ul>
    3. 3. The Hague, demographic data <ul><li>Offenders :15.800 / yr </li></ul><ul><ul><li>< 10 crim. rec.: 13.800 </li></ul></ul><ul><ul><li>≥ 10 crim. rec.: 2.000 </li></ul></ul><ul><ul><li>“ top 500” </li></ul></ul><ul><li>Drug addicts : 2.900 /yr </li></ul><ul><ul><li>(opiates / cocaine) </li></ul></ul><ul><ul><li>prevalence </li></ul></ul><ul><ul><ul><li>1% of 15-54yr </li></ul></ul></ul><ul><ul><ul><li>0,6-3% in ethnic minorities (>1% av.) </li></ul></ul></ul><ul><ul><ul><li>0-2,4% in central. districts </li></ul></ul></ul><ul><li>Criminal drug addicts : 2.000 / yr </li></ul><ul><ul><li>> 10 crim. records :1.600 </li></ul></ul><ul><li>Inhabitants : 475.000 (3rd city) </li></ul><ul><ul><li>47% ethnic minorities </li></ul></ul>
    4. 4. <ul><li>patients > 100 000 </li></ul><ul><li>employees > 8.000 </li></ul><ul><li>beds 2.700 </li></ul><ul><li>locations > 180 </li></ul>Expert – Respectful - Optimistic SOV <ul><li>The Hague addict. psych. probation </li></ul><ul><li>Patients 4000 25.000 2.000 </li></ul><ul><li>Employees 500 2500 90 </li></ul><ul><li>Beds 200 1100 - </li></ul>Parnassia Bavo Groep 2008
    5. 5. Repeat Offender Project (ROP) <ul><li>2002 Public Safety Policy of Government </li></ul><ul><li>ROP’s : intensive cooperation of </li></ul><ul><ul><li>Community </li></ul></ul><ul><ul><li>Public prosecutor </li></ul></ul><ul><ul><li>Police </li></ul></ul><ul><ul><li>Probation </li></ul></ul><ul><ul><li>MH & Addiction. </li></ul></ul><ul><li>RO : top 1% of offenders is responsible for </li></ul><ul><ul><li>>10% court sessions </li></ul></ul><ul><ul><li>37% of short detentions (<3 mnth) </li></ul></ul>
    6. 6. Role of Central Government <ul><li>ISD order (Oct. 2004) / extra prison cells (>800) </li></ul><ul><ul><li>2 year court order for most active RO </li></ul></ul><ul><ul><li>Partly in prison, partly outside (conditional) </li></ul></ul><ul><ul><li>Successor of (experimental) SOV order (2002) </li></ul></ul><ul><ul><li>Additional funding ROP </li></ul></ul><ul><ul><li>Larger cities (GSB) </li></ul></ul><ul><ul><li>Probation offices (Justice Dpt) </li></ul></ul><ul><ul><li>Forensic MH & Add. under control Justice Dpt. (2007) </li></ul></ul><ul><ul><li>Extra funding MH&A </li></ul></ul>
    7. 7. Role community The Hague <ul><li>RO Project structure (leading role of the Mayor!) </li></ul><ul><li>chain continuity </li></ul><ul><li>case register “top 500”, web based </li></ul><ul><li>performance contracts with </li></ul><ul><ul><li>Police ( adoption structure; top 10!) </li></ul></ul><ul><ul><li>Public Prosecutor (super fast justice) </li></ul></ul><ul><ul><li>PBG (MH & Add; MH Probation: 300 trajectories) </li></ul></ul><ul><li>extra funding for necessary links in chain </li></ul><ul><li>program evaluation </li></ul>
    8. 8. Top 500 definition and demography (The Hague) <ul><li>definition : </li></ul><ul><ul><li>> 10 offenses in the last 5 years, at least 1 in the index year </li></ul></ul><ul><ul><li>n=1536 (2000-2006) </li></ul></ul><ul><ul><li>Per year 600 -700 in contact with police </li></ul></ul><ul><ul><li>100 -150 new in top 500 </li></ul></ul><ul><ul><li>demography : </li></ul></ul><ul><ul><li>mean age 36 yr </li></ul></ul><ul><ul><li>93 % male </li></ul></ul><ul><ul><li>57 % ethnic minority </li></ul></ul><ul><ul><li>8 % employed </li></ul></ul><ul><ul><li>70 % single / homeless </li></ul></ul>
    9. 9. Top 500 criminal careers (The Hague) <ul><li>criminal career : </li></ul><ul><ul><li>criminal career 42% > 15 yr, mean 14 yr </li></ul></ul><ul><ul><li>start 57% < 18 th yr; mean 19 th </li></ul></ul><ul><ul><li>av. 44 offenses / 68 registered crimes </li></ul></ul><ul><ul><li>100% property, 67% violence </li></ul></ul>
    10. 10. Top 500: mental health aspects <ul><ul><li>86% addicted </li></ul></ul><ul><ul><ul><li>mostly poly drug; </li></ul></ul></ul><ul><ul><ul><li>39% (also) alcohol; </li></ul></ul></ul><ul><ul><ul><li>10% only alcohol or cannabis </li></ul></ul></ul><ul><ul><li>50% psychiatric diagnosis </li></ul></ul><ul><ul><ul><li>13% schizophrenia </li></ul></ul></ul><ul><ul><ul><li>personality disorders, ADHD, ASS, mental deficits) </li></ul></ul></ul><ul><ul><li>67% known at PBG (MH or Add.S.) </li></ul></ul><ul><ul><li>NB multi problem with many other criminogenic factors! </li></ul></ul>
    11. 11. Judicial modalities on entry (300 trajectories) <ul><li>Voluntary treatment (20%) </li></ul><ul><li>preventive approach </li></ul><ul><li>after expiration of title </li></ul><ul><li>Mandatory treatment / Diversion (60%) </li></ul><ul><li>(partly) conditional sentences </li></ul><ul><li>probational supervision </li></ul><ul><li>ISD order (20%) (‘ultimum refugium’) </li></ul><ul><li>2 years court order </li></ul><ul><li>modular treatment in prison (limited!) </li></ul><ul><li>addiction and MH treatment in 2 nd (extramural) phase </li></ul>
    12. 12. Different strokes for different folks <ul><li>Treatment matching factors: </li></ul><ul><li>motivation / risks / needs (what works) </li></ul><ul><li>psychiatric possibilities and limitations </li></ul><ul><li>conditions of the sentence </li></ul><ul><li>4 subgroups </li></ul><ul><li>complete rehabilitation (40%) </li></ul><ul><li>rehabilitation with enduring substitution / support (30%) </li></ul><ul><li>severe dual diagnosis / chronic care (20%) </li></ul><ul><li>severe behavioral disturbances / outreach (10%) </li></ul>
    13. 13. MP 10% DD 20% Subst 30% Recov 40% Subgroups from treatment perspective + + + + + + + + + + + + <ul><li>Outpatient / outreaching treatment </li></ul><ul><li>Outpatient drug free </li></ul><ul><li>Substitution programmes </li></ul><ul><li>Forensic outpatient </li></ul><ul><li>CDP outpatient </li></ul><ul><li>F-ACT </li></ul>(+) (+) + + + + + <ul><li>Inpatient / residential treatment </li></ul><ul><li>TX (modified TC criminal addicts) </li></ul><ul><li>EH (regular TC) </li></ul><ul><li>Motivational Center (3mnth; low thresh.) </li></ul><ul><li>Center Dual Diagnosis (CDP) </li></ul><ul><li>Forensic psychiatric ward (FPA) </li></ul>+ + + ! + ! <ul><li>Treatment in prison </li></ul><ul><li>Modular treatment on DFU and ISD unit </li></ul><ul><li>Prison TC?? </li></ul>
    14. 14. Treatment modalities: inpatient / residential treatment (n=50 PO’s / moment) Emiliehoeve TC (40) Triple-Ex modified TC (crim. add.)(40) Forensic psychiatric ward (46) Motivational Centre (low threshold)(24)
    15. 15. Treatment modalities: outpatient / outreaching treatment (n=120 / moment) forensic outpatient treatment in prison substitution program forensic ACT outpatient drug free
    16. 16. <ul><ul><li>Forensic outpatient </li></ul></ul><ul><ul><li>(25 FTE/ 800 cl) PO: 109 </li></ul></ul><ul><ul><li>Psychiatric and addiction diagnosis and treatment </li></ul></ul><ul><ul><li>Forensic Outreach Team (F-ACT) </li></ul></ul><ul><ul><li>Prison team </li></ul></ul><ul><ul><li>MH Probation </li></ul></ul><ul><ul><li>(90 FTE/ 2000 cl) PO: 205 </li></ul></ul><ul><ul><ul><li>Forensic reports </li></ul></ul></ul><ul><ul><ul><li>diversion / indications </li></ul></ul></ul><ul><ul><ul><li>supervision and case management </li></ul></ul></ul><ul><ul><ul><li>behavioral training in prison </li></ul></ul></ul><ul><ul><li>Reintegration modules, e.g. </li></ul></ul><ul><ul><li>Mat. Soc. Service (MJD) </li></ul></ul><ul><ul><li>(32 FTE/ 1800 cl) PO 100 </li></ul></ul><ul><ul><li>budget help </li></ul></ul><ul><ul><li>juridical advise, </li></ul></ul><ul><ul><li>help with housing, insurance, </li></ul></ul><ul><ul><li>ID, permits </li></ul></ul>Forensic ambulatory, a comprehensive outpatient chain <ul><ul><li>Forensic outpatient treatment </li></ul></ul><ul><ul><li>(25 FTE/ 800 cl) PO: 109 </li></ul></ul><ul><ul><li>Psychiatric and addiction treatment </li></ul></ul>forensic A CT
    17. 17. + + + + + + + + + + + + <ul><li>Day care / work </li></ul><ul><li>Vocational training (‘t Filiaal) / job coach (BV) </li></ul><ul><li>Day wages RO’s (Reflex) </li></ul><ul><li>Regular day wages (Clean River; Schoon&Zn)) </li></ul><ul><li>Day care </li></ul><ul><li>Walk in programme </li></ul>+ + + + NB Intensive MH probation !! MP 10% DD 20% Subst 30% Recov 40% Subgroups from reintegration perspective (+) (+) (+) + + + + + + + + <ul><li>Housing projects </li></ul><ul><li>Remise (guided living RO’s) </li></ul><ul><li>Re entry after Emiliehoeve and Triple-Ex </li></ul><ul><li>Shelter Center Dual Diagnosis (CDP) </li></ul><ul><li>Mi Casa / Woodstock </li></ul><ul><li>Turnaround houses </li></ul>+ + + + + + + + <ul><li>Material help (MJD) </li></ul><ul><li>budget and debts </li></ul><ul><li>insurance / ID / etc </li></ul>
    18. 18. Remise 25 drugfree places (for RO’s) Re-Entry (TX & EH) 30 drugfree places Remise 26 plaatsen Reintegration 2: housing projects MiCasa 47 places De overloop 15 places Woodstock 30 places
    19. 19. Vocational training ‘t Filiaal en job coach BV Reintegration 3a: vocational skills technics - health care - catering / restaurant – cleaning - roadman / gardening - individual programmes 70-100 pupils / wk
    20. 20. Schoon & Zn Clean River Kringloopwinkel Rehabilitation 3b: day care / day wages Reflex (for RO’s) Recycle-shop
    21. 21. Triple-Ex: ex-addict, ex-criminal en ex-unemployed 40 places
    22. 22. Outcome study: results SOV vs. regular detention and coercion projects (TX) <ul><li>part of a larger quasi-experimental pre-post study </li></ul><ul><li> t baseline t follow-up </li></ul>intervention 12 months pre-treatment phase 12 months post-treatment phase SOV (compulsory stay detention with treatment 18 months with 6 months community based aftercare) Compared to TX (modified TC; 9-12 months; coercion / voluntary; plus RE) FVK (inpatient treatment, non TC) Thanks to: Amsterdam Inst. Addiction Research (Maarten Koeter) and Parnassia Addiction Research Center (Peter Blanken)
    23. 23. Client characteristics TX at admission <ul><li>Background : </li></ul><ul><li>- ma le 100 % </li></ul><ul><li>- age 33 yrs </li></ul><ul><li>- lower education * 88 % </li></ul><ul><li>- non-western ethn. 39 % </li></ul><ul><li>Social situation : </li></ul><ul><li>- never any work 8.1% </li></ul><ul><li>- r ecent work 16% </li></ul><ul><li>- welfare 25.8% </li></ul><ul><li>- paid labour 11.3% </li></ul><ul><li>* LO/ LBO/ MVO </li></ul><ul><li>Drug abuse : </li></ul><ul><li>- poly drug 98% </li></ul><ul><li>- start at 22 yr </li></ul><ul><ul><li>Cocaine 89 % </li></ul></ul><ul><ul><li>Heroin 58 % </li></ul></ul><ul><li>- euro/month €1505 </li></ul><ul><li>Criminality: </li></ul><ul><li>- property 74% </li></ul><ul><li>- violence 48% </li></ul><ul><li>- drugs dealing 40% </li></ul>
    24. 24. Criminality during FU (>1 yr) (police & self-report) Reduction = > 50% red. & <5 crimes TIP: SOV 24 m TX-c 6.5 m TX-v 6.8 m Short =<3m n= SOV 154 TX-c 50 TX-v 51
    25. 25. Substance abuse at FU (>1 yr) (self-report) Reduction = > 50% red. & <6d dr/alc TIP: SOV 24 m TX-c 6.5 m TX-v 6.8 m Short =<3m n= SOV 154 TX-c 50 TX-v 51
    26. 26. Combined success on FU (SU & crim.) TIP: SOV 24 m TX-c 6.5 m TX-v 6.8 m n= SOV 154 TX-c 50 TX-v 51
    27. 27. Results ROP: community level 2002 73.500 2005 50.500 Analyse & Research Politie Haaglanden 2007
    28. 28. Results ROP: RO group level Analyse & Research Politie Haaglanden 2008
    29. 29. Conclusions <ul><li>Addiction Services & MH play a very important role in local safety policy (Repeat Offender Project) </li></ul><ul><li>The complex group of RO’s is characterized by addiction with much co-morbidity </li></ul><ul><li>A differentiated and comprehensive response is needed: </li></ul><ul><ul><ul><li>Residential / outpatient / outreaching / in prison treatment </li></ul></ul></ul><ul><ul><ul><li>Rehabilitation modules (finance, housing, work, education) </li></ul></ul></ul><ul><ul><ul><li>MH probation (specialized) </li></ul></ul></ul><ul><li>PBG: in this integrated service package (incl. harm reduction) TC’s flourish. The total results are very promising. </li></ul><ul><li>Future: better treatment in detention (prison TC!!) and modalities for clients with mental deficits. </li></ul>
    30. 30. Thank you !

    ×